Provider Demographics
NPI:1154936383
Name:HASKELL, ERICA CARLA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:CARLA
Last Name:HASKELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W MARCH LN STE C&D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6414
Mailing Address - Country:US
Mailing Address - Phone:209-636-5353
Mailing Address - Fax:
Practice Address - Street 1:1803 W MARCH LN STE C&D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6414
Practice Address - Country:US
Practice Address - Phone:209-636-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist